In a newborn, the patent ductus arteriosus still has the potential to close on its own without intervention. Thus, in newborns, additional time may be allowed for the patent ductus arteriosus to close on its own if the heart failure can be easily managed. If symptoms are severe, such as in a premature infant, or if it is felt that it is unlikely to close on its own, however, medical or surgical closure is pursued.
If a patent ductus arteriosus is still present beyond the newborn period, it will generally never close on its own. Closure is recommended in such cases to prevent the future risk of endocarditis.
In newborns, a medication such as indomethacin or ibuprofen can be given. These medications are given in the stomach and can constrict the muscle in the wall of the patent ductus arteriosus and promote closure. These drugs do have side effects, however, such as kidney injury or bleeding, so not all babies can receive them. Because of the potential side effects, the baby must have lab values checked before medications can be given. If the lab values are not normal or if the medications do not work, surgery can be performed and the patent ductus arteriosus tied off (ligated).
Medications are generally only successful in newborns. In older infants and children, options for closure include surgery or closure in the cardiac catheterization laboratory with a device or coil.
During the cardiac catheterization procedure, the patient is either sedated or placed under general anesthesia (depending on age) and catheters are placed into blood vessels in the groin. The catheters are then positioned in the aorta close to the ductus arteriosus, and a picture (called an angiogram) is taken to define the shape and size of the of the ductus arteriosus. Various devices are now available to close the ductus. If the ductus is small, a coil may be placed within the vessel, but if larger, different types of plug-shaped devices can be used to occlude the vessel.
The ductus arteriosus may also be closed with surgery. A small incision is made between the ribs on the left side, and the ductus arteriosus is tied (ligated) and cut. Surgical closure of the patent ductus arteriosus can be performed at any age, and is specifically recommended in some situations such as a very large patent ductus arteriosus or other unusual anatomy.
The risk of complications with any of these treatments is low, determined mostly by how ill the child is prior to treatment.